Workplace training practices in the residential aged care sector

Australia's population is ageing and is projected to increase to be about one-fifth of the general population in the next 30 years. Aged care workers have therefore a vital role to play in ensuring that the needs of the aged are met. Recognition of skills and the training needs of this group of workers are examined through an analysis of the aged care industry and on-site interviews with a range of personnel, including management, the workers themselves, and members of relevant registered training organisations.

• Managers of residential aged care facilities appreciate that effective skills recognition and training for its personal care workers is crucial to helping them meet aged care facility standards. Such training will enable staff to more easily understand the requirements of their jobs and the importance of accurate record-keeping.

• Personal care workers have a poor uptake rate of recognition of prior learning even amongst workers with substantial experience in the industry. They show a preference for undertaking the training instead and learning the theory behind their practices. Their managers also favour training over existing skills recognition as a vehicle for workplace culture change.

• Where it is agreed that recognition of prior learning is a viable option, more realistic strategies are required that rely more on practical demonstration of their skills and knowledge and less on paper-based evidence.

• Registered training organisations need to ensure that training supports the aged care facility's goal, is delivered on site where possible, has theory embedded with practice, provides additional learner support and is structured and paced to the needs of the particular groups of workers.

• Associated features of good practice in training from the case studies include increased collaboration between aged care facilities (to achieve critical mass of numbers for example) and easier access to training information for managers.

A focus of this research is the recognition of skills and training needs of personal care workers in the residential aged care sector of the community services industry. The proportion of those aged over 65 years in the Australian population is growing, creating increased demand in the industry. At the same time, the personal carer workforce is ageing, with a current average age of 50 years. There will be a growing need to train new personal care workers to keep up with industry demand, as well as provide ongoing training to the existing workforce. The research focuses particularly on why we need to train existing personal care workers, what barriers exist to cost-effective recognition and workplace training, and what models or strategies aged care facilities and registered training organisations have developed to improve recognition and workplace training.

Until recently there has been anecdotal evidence, but no confirmed data, about the profile of personal care workers. However, in 2004 the National Institute of Labour Studies conducted a survey of the residential aged care workforce—The Care of Older Australians-—which provides statistical information about personal care workers (Richardson & Martin 2004). Of the 116 000 direct care employees working in residential aged care, 67 000 are personal care workers— representing a significant group within the workforce and the group providing the majority of dayto-day resident care. The study shows that 94% of workers are women and 43% of workers are 45 years or younger, compared with 67% of all Australian workers. Only 8% of personal care workers are permanent, with the highest proportion being permanent part-time employees.

The first phase of this project included an environmental scan of worker and organisation profiles, current legislation, and other factors impacting on training, recognition of training, and the assessment needs of workers and aged care facilities. Based on data gathered in the scan and preliminary research, eight sites were selected for site interviews. Interviews were conducted in Victoria, Tasmania, New South Wales and the Australian Capital Territory, and sites were selected to represent a range of different types of workplaces typical across the industry. At each site interviews were conducted with a range of people to gather a range of different perspectives on recognition and training issues. These include the chief executive officer or manager, staff responsible for training, a representative from the partner registered training organisation and a group of personal care workers.

Residential aged care in Australia is grouped into two major categories—high-level care (previously called 'nursing homes') and low-level care ('hostels'), and the funding ratio for facilities is based on a calculation of the number of residents requiring various levels of support. The industry is regulated by national accreditation standards linked to a funding formula. Although the standards do not mandate necessary qualifications for personal care workers, it would be difficult for a facility to achieve the standards without a staff training strategy focusing on key areas.

Managers indicated the need for training to be both an integral part of the organisation's business and closely aligned to its business plan, with training necessary for all facility staff, including personal care workers. They also identified the importance of personal care workers understanding their role in maintaining quality and helping the facility to meet accreditation standards. Training was cited as a crucial step for workers to improve their skills in maintaining vital records and providing quality resident care. Managers believed that, if industry is to provide quality care in the current changing environment, workers must possess generic 'employability' skills, as they are known in the vocational education and training (VET) sector.

The role of the personal care worker is changing as a result of facilities' accreditation requirements and also 'Ageing in Place', a policy introduced under the Aged Care Act 1997. This policy has changed the profile of residents entering aged care facilities. Residents are now older and more dependent when they enter facilities, thus requiring more intensive care. This means that workers need to have training in areas such as manual handling, communication and negotiation skills; dealing with challenging behaviour; and assisting with medication. The major vocational education qualification for personal care workers in the industry is the Certificate III in Aged Care Work. It has been noted in the High level review of training packages that aged care workers will require 'the acquisition of new interpersonal and highly context bound skills as well as those more readily transferred' (ANTA 2003, p.30).

Features of good practice in workplace training

At the majority of sites where interviews took place, managers reported their preference for recruiting workers according to their personal attributes and suitability for the role rather than according to their vocational education qualification (such as the Certificate III in Aged Care Work). Managers confirmed that they preferred to recruit the 'right' people and then train them. They cited the attributes sought after in new recruits as flexibility, sensitivity, an understanding of care dignity and respect, empathy, people skills, honesty, dedication, life experience and rapport with the elderly. Workers and managers interviewed confirmed the importance of recruiting the right individuals for the job and then providing them with opportunities to gain the certificate III qualification.

Workers identified that the main benefit they gained from their certificate III training programs was a good understanding of the theory behind the practical activities they perform daily. Many commented that they had been doing routine tasks with little understanding of why they had been told to do them in a certain way. They felt the training provided them with a better grasp of occupational health and safety and also an understanding of their role in the accreditation process. Most reported an increase in both confidence and communication skills, allowing them to interact more effectively with the residents, their families and other team members. A number of workers commented on the personal value of the training, as it had been the first post-school qualification they had achieved, and had allowed them to learn a lot more about current aged care practices.

Most importantly, they valued the approaches their trainers had taken to give the training sessions a practical focus; to ensure that they were paced to suit individuals and aligned to the facility's practices; and that they offered a positive learning experience. Several workers mentioned previous unsuccessful learning experiences and valued the training being provided by their organisations on-site, to fit around their work and family commitments.

There are increasing workplace literacy demands on personal care workers who are required to read instructions, follow accreditation and documentation processes and access information about medications and safety aspects of their job. Managers and trainers working in the sector also commented on the need for workers to have literacy support to enable them to access and succeed in training. Several workplaces surveyed during the project had accessed Workplace English Language and Literacy (WELL) Program funds to allow workers to improve their literacy and 'learning to learn' skills so they could complete certificate III level training. Trainers had developed a range of practical assessment strategies to overcome workers' literacy skills and lack of self-confidence. A combination of oral questioning and 'working a shift with the worker being assessed' was favoured over paper-based assessment methods.

The way forward

While there was widespread support for face-to-face practical training, there was also industry interest in the use of technology to overcome some of the barriers imposed by isolation, shift work, limited funding and transient workers. It is not envisaged that technology can actually replace face-to-face training, but managers, trainers and workers all welcomed increased opportunities to access up-to-date training materials online or through multimedia resources such as the Aged Care Channel broadcasts. Current access to technology in aged care facilities is poor, so there will need to be an injection of resources and training into this area. Staff at several sites were exploring the use of technology for their personal care workers to maintain required documentation. It seems the sector is on the brink of more widespread access to and interest in the use of technology. This will have ramifications for the range of delivery options that can be blended to meet the training needs of personal care workers.

There is overwhelming confusion among managers and workers in many aged care facilities about the vocational education and training sector, the range of qualifications and pathways available, the requirements and available funding subsidies, and the training resources available.The two cultures, the aged care workforce and vocational education and training professionals, need to be able to speak to one another more effectively. Training organisations need to be responsive and flexible in their approach to aged care facilities and be prepared to customise their delivery to the needs of the workplace.

Lack of access to current information about training options could be overcome by strengthening and resourcing local networks. At several sites facility staff had harnessed local support for their training programs and, to make the cost of provision viable, a number were offering training programs which included workers from other local aged care facilities. Suitable training pathways for personal care workers need to be identified to meet the predicted gap caused by reduced numbers of, and increased demand for, available registered nurses. As described in the recent National Institute of Labour Studies workforce survey (Richardson & Martin 2004) four-fifths of personal care workers have completed certificate III level training but will require additional training either through a nursing or non-nursing pathway, depending on the requirements of the particular facility.

The role of recognition of prior learning

There are some tensions within the industry about recognition of workers' skills and experience. These tensions revolve around the rights of workers to access recognition of prior learning and the cost-effectiveness of this option to the organisations, against the overwhelming message of the value that training offers to both individuals and their organisations. During their strategic audit of the aged care industry in Victoria, Hoffman, Nay and Garratt (2002) reported that the aged care industry is attempting to implement major change, in order to equip the workers to meet the changing demands of their job and to meet the needs of the growing aged care population. They felt that recognition of prior learning should only be used if the workers concerned were able to demonstrate current knowledge and practices, and in some workplaces, conducting training may be a more appropriate way of supporting new processes and procedures.

While the majority of personal care workers interviewed had lengthy experience in the same or similar roles in the industry, most had opted to complete the full certificate III qualification. At sites surveyed where recognition of prior learning was successfully taken up, it was due to the approach taken by the registered training organisation. Trainers had worked collaboratively with their partner facility. They had mapped the recognition approach to the job rather than to the units of competence and had developed practical, achievable strategies to help individual workers provide the required evidence. These strategies included working a shift alongside the worker wanting recognition, gathering third-party reports from supervisors and conducting an interview with the worker, using structured questioning to determine their level of underpinning knowledge as well as their attitude to the job.

There is a demand for trained, confident workers within the residential aged care sector and for new and expanded skill sets for existing workers. Recognition may not be the solution to extending the skill base and responding to the changing requirements of the role. Targeted, easily accessible, workplace-delivered training mapped to the facility's requirements needs to continue to be delivered to existing workers and also to the significant number of new workers who will need to be recruited into the industry to cater for future demand.